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NPI Code Detail

MEDICARE: AFFORDABLE DENTAL CARE , LLC

MEDICARE: AFFORDABLE DENTAL CARE , LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11700080793OTHERGANPI
21255510624OTHERGANPI

General Provider Information

NPI Number : 1619482635
Entity Type Code : Organization
Provider Name (Legal Business Name) : AFFORDABLE DENTAL CARE , LLC
Provider Business Mailing Address
First Line : 3993 LAWRENCEVILLE HWY NW STE 100A
Second Line :
City : LILBURN
State : GA
Zip : 30047-2831
Country : US
Telephone Number : 770-279-2020
Fax Number : 770-279-1222
Provider Business Practice Location Address
First Line : 3993 LAWRENCEVILLE HWY NW STE 100A
Second Line :
City : LILBURN
State : GA
Zip : 30047-2831
Country : US
Telephone Number : 770-279-2020
Fax Number : 770-279-1222
Authorized Official
Title or Position : DENTIST
Name : DR. PRAVEEN GUDIPATI
Credential : DMD
Telephone Number : 770-279-2020
Provider Enumeration Date : 12/13/2017
Last Update Date : 12/13/2017

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Directions to “AFFORDABLE DENTAL CARE , LLC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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